During one of the editors first week in Iraq, a soldier with an obvious severe head injury from a roadside bomb was brought in. He was rapidly tagged as “needing urgent transfer” to the neurosurgery team in Balad. While waiting for the helicopter his nurse fortunately noted that he was becoming more hypotensive, and alerted one of the trauma surgeons. A more thorough evaluation was performed, a FAST exam demonstrated hemoperitoneum, and the patient underwent emergent splenectomy with subsequent rapid stabilization and then transfer. The most important point of this chapter is: The presence of a head injury should not change the initial treatment of the trauma patient. As a corollary, the premature transfer of a trauma patient to a Neurosurgeon prior to appropriate initial treatment will adversely affect outcomes.